Effects of herbal compounds on various aspects of endometriosis treatment: a systematic review.

OBJECTIVE: Endometriosis means the presence of tissue similar to normal endometrium outside the uterus. Although surgical, hormonal, and analgesic treatment relieves symptoms and improves fertility, it is associated with side effects and a high recurrence rate. Alternative medicines like medicinal plants have been used for the treatment of chronic diseases. Given the global importance of endometriosis as a chronic disease affecting over 15% of all women in their fertile period, this systematic review aimed to give a comprehensive view of research on medicinal plants. MATERIALS AND METHODS: Comprehensive searches were performed on three databases, including PubMed/MEDLINE, Web of Science Core Collection (Indexes = SCI-EXPANDED, SSCI, A, and HCI Timespan), and Scopus, to identify papers published until June 2023. Keywords, such as "Endometriosis" and "Herbal Medicine", were used to search. A manual search of valid journals followed by a manual search of the references of the retrieved full-text articles was performed. All retrieved articles were imported into a database into Endnote X9. Articles that did not meet the inclusion criteria were excluded from the study, and the full texts of all the articles that met the inclusion criteria were assessed. Studies that evaluated the effects of herbal compounds on various aspects of endometriosis treatment were included in the review. RESULTS: In total, 11 studies were included in the present study. The evidence showed that in addition to safety, drugs available alongside treatments could play an effective role in improving the symptoms associated with endometriosis. In this study, the positive results of using Chinese treatments were reported in aspects such as fertility rate, pain, endometriosis recurrence rate, quality of life, sexual function, CA-125 level, and menopause symptoms. CONCLUSIONS: A wide range of preclinical and clinical studies evaluated the effectiveness and safety of medicinal plants in the treatment of endometriosis symptoms. Thus, alternative treatments for endometriosis with no or low side effects should be included in the holistic treatment of endometriosis upfront. However, there is still a need for well-designed trials to investigate standard interventions and specific and safe doses of herbal medicines.

Eyes, menstruation and endometriosis.

Vicarious menstruation refers to cyclical bleeding outside the uterine cavity during the menstrual cycle. Haemolacria, or blood in tears, is a rare medical phenomenon that can occur with menstruation or in association with endometriosis. Endometriosis, defined by the presence of endometrial-like tissue in extra-uterine sites, affects around 10% of fertile women; the ocular system is one of the rarest sites it can be present in. Endometriosis usually requires a biopsy for diagnosis, and the anatomic difficulty of obtaining a biopsy of the ocular system makes ocular endometriosis diagnosis more obscure. However, few cases have been described in the literature and due to the psychological, physical, and social implications of haemolacria on the patient, treatment is of utmost importance. We reviewed the literature on ocular endometriosis and ocular vicarious menstruation with the aim to discuss the clinical presentation, necessary workup and various treatment modalities, while also shedding light on the connection between the eyes and endometriosis in general. It is hypothesised that uterine endometrial cells can travel lymphatically or haematogenously and deposit extra-uterine endometriotic lesions that bleed in response to hormonal changes in the menstrual cycle. Additionally, the conjunctival vasculature has been found to be responsive to hormonal changes due to the presence of oestrogen and progesterone receptors, causing bleeding at the corresponding sites, even without endometriotic lesions. Clinical correlation of the haemolacria with the menstrual cycle can suffice for a diagnosis of vicarious menstruation, and thus opens the possibility of treatment to provide symptomatic treatment for the patient.

Pudendal Neuralgia: Two case reports with laparoscopic nerve decompression.

Pudendal neuralgia (PN) is a rare and underestimated condition. The reported incidence by the International Pudendal Neuropathy Association is 1/100000. However, the actual rate may be significantly higher, with a propensity for women. It is most frequently caused by an entrapment of the nerve at the level of the sacrospinous and sacrotuberous ligament, also known as pudendal nerve entrapment syndrome. Due to the late diagnosis and inadequate management, pudendal nerve entrapment syndrome often leads to considerable reduction in the quality of life and high health care costs. The diagnosis is made using Nantes Criteria, in conjunction with the patient's clinical history and physical findings. Clinical examination with an accurate assessment of the territory of the neuropathic pain is mandatory to set the therapeutic strategy. The aim of the treatment is to control the symptoms and it usually starts with conservative approaches which include analgesics, anticonvulsants, and muscle relaxants. Surgical nerve decompression can be proposed after failure of conservative management. The laparoscopic approach is a feasible and appropriate technique to explore and decompress the pudendal nerve, and to rule out other pelvic conditions that can cause similar symptomatology. In this paper, the clinical history of two patients affected by compressive PN is reported. Both patients underwent laparoscopic pudendal neurolysis suggesting that the treatment for PN should be individualised and carried out by a multidisciplinary team. When conservative treatment fails, laparoscopic nerve exploration and decompression is an adequate option to propose and should be performed by a trained surgeon.

Colorectal endometriosis: ample data without definitive recommendations.

The preoperative work-up and optimal surgical approach to colorectal endometriosis is a highly studied topic lacking definitive recommendations. Synthesis of the available data can be extremely challenging for surgeons due to the heterogeneity of existing comparisons, a variety of studied surgical outcomes, and a predominant focus on operative complications. While these considerations are extremely important for surgeons performing such complex gynaecologic surgery there is still much to be desired with regards to evidence based guidelines for the preoperative assessment and surgical technique for colorectal endometriosis. Having an established guideline stating in which clinical situations endometriosis surgeons should performing rectovaginal shaving, versus discoid excision, versus segmental resection would be extremely important for all pelvic surgeons, even those operating in high-volume centres dedicated to the surgical management of complex endometriosis. This perspective highlights the shortcomings of the available data and attempts to create an algorithm surgeons can follow when performing surgery for colorectal endometriosis. This algorithm is based on our expert opinion after synthesising available data.

COVID-19: A Surgical Perspective for when the curve flattens.

At the present time it is clear that our global healthcare community was not prepared to face the COVID-19 pandemic. Hospitals in the hardest hit areas have been transformed to COVID centres. Surgical societies have recommended postponing non-emergency surgery, and have given recommendations for triaging the ever- growing backlog of patients. However, simply resuming these non-emergency surgeries may lead the healthcare system into a second disaster. If healthcare policymakers around the world do not systematically consider how to resume normal surgical services, hospitals will be quickly overwhelmed, vital resources will be depleted, and patients and providers alike will face an increased exposure risk. This perspective serves to highlight certain aspects of returning to normal that physicians and hospital administrators alike must consider to avoid potential catastrophe.

The in vivo production of Spodoptera littoralis nuclear polyhedrosis virus.

The in vivo production of the nucleopolyhedrovirus (NPV) of the Egyptian cotton leafworm Spodoptera littoralis was studied experimentally. Larvae (7 days old) of 30-50 mg were experimentally infected with a range of NPV doses then harvested alive at various times after dosing to determine the effect of dose and incubation time on NPV productivity. Maximum NPV production achieved after 7 days incubation was 1.86 x 10(9) polyhedral inclusion bodies (PIBs) per larvae using an inoculum of 1 x 10(4) PIBs. Adjusting the inoculum dose had limited impact on NPV productivity but the correct selection of harvesting time was crucial in maximising the yield, both to achieve peak NPV production in individual larvae and to avoid losses from the death and disintegration of larvae if harvesting was delayed too long.

Microbial Contamination in Spodoptera littoralis Nuclear Polyhedrosis Virus Produced in Insects in Egypt

Spodoptera littoralis nuclear polyhedrosis virus produced in Egypt, for use in field trials for the control of S. littoralis on cotton, was subject to microbiological examination to quantify microbial contamination. Bacteria were found to be present at 10(6)-10(9) colony-forming units/ml in virus suspensions containing 2.1 x 10(9) polyhedral inclusion bodies/ml. Batches were found to contain between 2 and 11 different species of contaminant microbes. No primary human pathogens of medical importance were found. The dominant species were fecal Streptococci and two Bacillus species, B. cereus and B. sphaericus. The Streptococci were derived from the normal gut flora found in healthy insects; the Bacillus species were common opportunistic saprophytes which gained access to the product by colonizing dead larvae and diet waste. Purification methods based on centrifugation were found to be ineffective in removing bacteria and improved methods of hygiene and harvesting appeared to be of more value in reducing contamination.